Landmark study shows low breastfeeding rates cost US $13 billion/year

A study by two Massachusetts researchers published today in Pediatrics found that failure to comply with medical recommendations around breastfeeding is costing the US $13 billion per year, with 911 excess, preventable deaths. Those recommendations suggest newborns breastfeed exclusively for 6 months with continued breastfeeding for at least the first year of life. The authors compared the costs of 10 pediatric diseases at current US breastfeeding rates with what those costs would be if 90% of new mothers complied with the medical recommendations. For each disease, costs were calculated for direct cost of health care, indirect costs such as time missed from work, and the cost of premature death.

Of the 911 excess deaths, 95% are in infants. The infant deaths are from Sudden Infant Death Syndrome (SIDS), necrotizing enterocolitis (NEC, a disease seen primarily in preterm infants), and lower respiratory tract infections such as pneumonia, said the study’s lead author, Dr. Melissa Bartick of Cambridge Health Alliance and an instructor of medicine at Harvard Medical School.

While nearly 3/4 of all US mothers initiate breastfeeding, only 32% are breastfeeding exclusively at 3 months. Just 12% of US infants meet the medical recommendation to breastfeed exclusively for 6 months. Only 22% are breastfeeding at all at one year. Other countries, such as Sweden and Kenya, do much better.

Dr. Bartick notes, “People shouldn’t blame moms, because they are really not supported well from the moment their babies are born.” According to Bartick, what happens in the first hours and days of life can dramatically influence whether mothers are still breastfeeding months later. CDC data shows that the average US maternity hospital performs quite poorly when it comes to providing evidence-based care around infant feeding.

For example, research shows that keeping mother and baby together, skin-to-skin, uninterrupted, in the first hour of life is something vitally important to ultimate breastfeeding success, but this does not happen consistently in most US hospitals. Only 86 US hospitals are certified as Baby-Friendly, a WHO/UNICEF quality initiative on breastfeeding, which includes avoiding separation of mother and baby, and not introducing formula without a medical reason.

Inadequate worksite accommodation and lack of social and cultural support also contribute to poor breastfeeding rates, as does aggressive marketing of infant formula, she adds.

Bartick and co-author Arnold Reinhold point out that the vast majority of cost savings described in the study could be achieved even if the exclusive breastfeeding rate at 4 months was 80-90% and if the rate of any breastfeeding at 6 months was 90%. That is a potentially achievable goal, provided there is strong central leadership, as there is in other developed countries with high breastfeeding rates, notes Bartick. “After all, it wasn’t that long ago when rates were 100%,” says Reinhold.

The study’s release comes on the heels of a letter sent to Congress on March 16, asking for the appropriation of $15 million per year to help build the support necessary to breastfeeding rates. The letter was signed by 90 organizations, including the American Academy of Pediatrics, the American Congress of Obstetricians and Gynecologists (ACOG), and the American Academy of Family Physicians.

The authors based the excess disease burden associated with lack of breastfeeding on a comprehensive 2007 report from the US Agency of Healthcare Research and Quality (AHRQ). For each disease studied, the authors used the type and duration of breastfeeding described in the AHRQ report’s conclusion. For example, the excess cost gastroenteritis was based on exclusive breastfeeding for six months; the cost of asthma used any breastfeeding for 3 months.

The largest costs came from premature death due to Sudden Infant Death Syndrome (SIDS), necrotizing enterocolitis (NEC), and lower respiratory tract infection, followed by the overall costs of otitis media (middle ear infections) and atopic dermatitis. The other diseases studied were childhood asthma, childhood obesity, type 1 diabetes in childhood, gastroenteritis, and childhood leukemia.

Although breastfeeding also has been linked to lower rates of maternal cardiovascular disease, type 2 diabetes, breast cancer and ovarian cancer, these costs were not included in this study. In particular, despite convincing data from the AHRQ report that type 2 diabetes in children is higher in people who were not breastfed, it could not be included in the study because the AHRQ report did not have enough data on the duration and exclusivity of breastfeeding required to reduce risk. Thus, the true cost of poor US breastfeeding rates is likely to be significantly higher than $13 billion.